As we approach the end of the year there are some folks who may be wondering how to close out their therapy sessions because they’re running out of benefits, coverage, or simply coming to a close with their therapy sessions. It can be hard to close therapy out. Goodbye to therapy sessions has been difficult for as long as I can remember doing therapy. I use to ask my supervisors how one could close out therapy sessions in a kind way and I’ve heard everything under the sun.

It’s so important that however we handle therapy termination the client is involved throughout the process. We really want to leave as much time as possible to prepare someone for these conversations and closing activities. Often times when the ending is decided on collaboratively then the client knows it’s coming and can address their concerns, feelings or just generally have time to chew on the ending with their therapist.

The most helpful advice comes from Dr. Dowtin at PlayfulLeigh Psyched who suggests preparing therapy to close well in advance and to have a closure activity. One of my all time favorite activities was decorating a picture together so they could keep it, frame it, etc. I have several cards and sweet notes from children and families I served in various areas in the US (with their names removed of course because HIPAA). I too have written letters to clients thanking them, highlighting special moments in therapy or their growth, and honoring the transition as we close their time in therapy. You can write a letter, choose a special song, or do some other closing activity to signify this time together and the client’s journey. Sometimes people will feel a closure activity could be as simple, but powerful as highlighting all you’ve done in therapy.

That’s actually my favorite part of completing therapy with a client; reflecting on their gains. I love mirroring where they started and where they are now. I love seeing them fulfilled with their efforts and the support they got and gave themself. It’s even more special to me when a client can reflect on these gains themself. I’m happy to do it for them because I know it’s not always easy to see where we’ve changed, but it’s so great when people tell me “when I started, I never could’ve figured out how I was feeling, let alone tell my mom” or “I’ve come so far and now have open communication with my partner”! Wow do I love to hear people make these changes.

And sometimes there aren’t magical shifts and a person desires a different type of therapy or fit. That’s okay and can be honored too. Several people come to me after working with several therapists who weren’t welcoming around their intersecting identities. I know we assume therapists should be inclusive, but so many are not. For some therapists they simply don’t specialize in something you need like if they work with anxiety but not trauma, you may need to start working with a trauma specialist. It’s important to know why you’re closing therapy with one provider so you can be sure to get what you need in the next therapy relationship.

Please also get appropriate referrals from your community or therapist. Your therapist may even be willing to stand by for a few weeks or month while you reach out, attend free 15 minute therapy consultations and find a good fit therapist for your needs. They don’t have to, but you can totally ask them to hang out for a short while so you can secure a new therapist.

Whether you’ve graduated from this type of therapy and are ready to level up to a different type of therapy, need a break from therapy while your benefits come in, or are simply done with therapy I honor the work you’ve done. I honor your trauma recovery. I honor you and your therapeutic journey.

Let me just say I truly wish the government would stop allocating taxes for war and start putting all of that money to good use, for your therapy. Yours, mine, everyone’s! Now that I’ve said what I truly believe I can share more about ways one can get access to therapy when they aren’t independently wealthy.

If you have insurance you can call and explain that you have a medical necessity for therapy services and ask for a list of in-network providers. If they don’t have an in-network provider, but would reimburse you for services with an out-of-network provider you can find out exactly what they would reimburse you. You can ask what percentage they’ll reimburse you if you go out of network and get the instructions for reimbursement sent directly to you or jot them down as you discuss your insurance company’s reimbursement process. Some people also ask about how their health spending account (HSA) can help out with therapy costs. I always encourage people to get this stuff in writing or get specific instructions since things change and because I’ve seen several folks struggle with reimbursement and I have no say in or responsibility around what paperwork is submitted or what someone is reimbursed.

I’d also check with speciality clinics you may be involved in. For example, I’ve worked on rotations or in clinics supporting people with cancer, spinal cord injury, and so on and provided people therapy for short-term services or services that are covered in one way or another through the person’s clinic. If you’re part of a clinic for your overall healthcare please be sure to see if they have a therapist or psychologist who you can be referred to for therapy.

Now if you’re under insured or not insured there are some options too. My favorite option for folks who are not insured is Open Path Collective. Folks can search for a therapist currently accepting clients, register for a one-time fee of $59, and then pay weekly session fees of $30-$60. There are incredible therapists on Open Path Collective and patients can find someone who really wants to contribute to the collective and offer 1 or more sliding scale slots (which means a lower fee for you).

For clients who are BIPOC or part of other marginalized communities I strongly recommend seeking therapy scholarships. There are some therapy scholarships available that can be found at Inclusive Therapists, Black Girls Smile or funds that pay a certain amount per session such as the The Loveland Fund or Mental Health Fund. There are also individual therapists or small group practices (such as this one with slots available at $60/session) or community or training clinics that sometimes offer a therapy scholarship or lower fee options.

Things I Want You To Consider

1. Most clinicians won’t be able to tell you how many sessions it takes to get to what you’re working toward. However, you can ask how many sessions they can provide you services at the fee they’re offering. Can they offer you eight sessions at this lower rate? Can they offer three months on their sliding scale? Try to get an idea of what capacity they have so you know how much time you have to get to the things you want to get to and so you can plan your next steps.
2. Consider costs outside of the session to help you decide how much you’ll need to budget. For example, do you need to travel to get to session or better internet access? If so, how much is public transportation for your travels, costs of gas and parking, etc.? What other costs can you account for? What else do you need to budget in to set yourself up for success with starting or reengaging in therapy?

This is a more than frustrating process and I’m really sorry our field has all the praise of being helpful, but none of the support it needs to provide accessible, sustainable and quality mental health care for the masses. I hope the few suggestions above will be somewhat helpful with the understanding that it may take a long time and lots of “no’s” before you find someone who still has an opening or who is a good fit for your needs. If you need someone who is queer or trans affirming, uses your primary language, or fits another need it can be that much smaller of a pool to search from. Please be gentle with yourself as you search and know that there are a few supports while you seek your therapeutic fit including Trans Lifeline or 988 Suicide and Crisis Lifeline. You are so worthy of getting the care you need and desire. Wishing you a speedy and good therapeutic fit for your needs!